The wisdom of retention. Part 1

 As time passes by, teeth are not stable and there is a life-long tendency for teeth to move. Some teeth are relapsing as you are reading this post, but don’t worry!  You will learn some great tips on how to build a long-term retention plan to minimize the chance of relapse.  

Why do you need to use retainers?

Ninety per cent (90%) of your patients will experience relapse or age-related alterations of dentition after debond.1

Your retention plan is an insurance for stability and long term success. It minimizes relapse and future displacement. Using properly designed retainers helps you avoid wasted time, money and disappointment for your patient. 

For the best conclusions of the stability studies conducted at UW, read Bob Little’s post on stability and relapse.

What options do you have for retainers?

You have a choice of bonded or removable retainers like Hawley/Wrap and Essix type of retainers.

According to two recent Cochrane review, there is no current evidence that one retention method is superior to another.2

Your experience as an orthodontist and the individual needs of your case dictate the retention strategy.  Continue reading this post to learn about bonded retainers. Our next post will cover removable retainers. 

Bonded retainers

According to most studies, lower incisors have the highest risk of relapse. Therefore, many clinicians consistently bond a lingual retainer on L3-3. You can either bond all anterior teeth or use a rigid wire bonded only on the canines.

A retainer bonded only on the canines might not prevent the incisors from rotating or moving forward. Make sure it fits well and touches each tooth to minimize this risk.

 

Technique

Bonding retainers is technique sensitive: make sure the field is dry and the wire fits passively. You can use flowable or regular composite. 

img_7833-1
Bonding retainers is technique sensitive

If you bond upper anterior teeth make sure you have occlusal clearance with articulation paper and adjust if needed. They can easily debond if there is any interference.

Indications – from start to finish

Plan for your retention strategy before you start active treatment according to your case’s needs so you avoid overlooking important information at the end. There are some specific situations when bonded retainers should be considered.  Making a note in your chart is essential.

Tip #1: Bond retainers for closed diastemas. They have a high chance of relapse.

Tip #2: Bond retainers for extraction spaces that were hard to close.

Tip #3: Bond teeth that were severely mal-positioned or ectopic.

Tip #4: Bond teeth that were severely rotated or impacted.

Tip #5: You can use a bonded retainer for edentulous spaces until restorations are in place.

645601-medjine-valcourt-retention-intraoral-left-1
Maintaining space for future implant

Why to love them?

  • Bonded retainers maintain alignment for 15 years or more if properly monitored and taken care of.5
  • Compliance from the patient is minimal. 
  • Overall they are predictable and can be removed anytime.
  • Settling of posterior teeth can occur.

Are there any pitfalls?

o-l-2
Calculus build-up with bonded retainer
  • Accumulation of plaque and calculus tend to be greater in bonded retainers.4
  • Sometimes they fail and patients might not notice the relapse for a while.
  • Bond failures and wire breakage could occur due to biting or occlusal forces.5  
  • They can become active over time.

What can you do to avoid complications?

  • Make sure the retainers fit passively when you bond them.
  • Make sure to monitor the retainer in case it fails.
  • Emergency appointments may be required to repair the retainer.
  • Give instructions on how to maintain good oral hygiene and make sure they receive regular cleanings.

In the end, strive for high quality results and maintain them indefinitely with proper retainers. We have covered many aspects of bonded retainers in this post. Our next post will cover various types of removable retainers. Stay tuned!

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Authors

Fedora & Mina


References

1.Little, R.M.; Riedel, R.A.; and Artun, J.: An evaluation of changes in mandibular anterior alignment from 10 to 20 years postretention, Am. J. Orthod. 93:423-428, 1988.

2. Littlewood SJ, Millett DT, Doubleday B, Bearn DR, Worthington HV. Retention procedures for stabilising tooth position after treatment with orthodontic braces. Cochrane Database of Systematic Reviews 2016, Issue 1. Art. No.: CD002283. DOI: 10.1002/14651858.CD002283.pub4

3. Yu Y, Sun J, Lai W, Wu T, Koshy S, Shi Z. Interventions for managing relapse of the lower front teeth after orthodontic treatment. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD008734. DOI: 10.1002/14651858.CD008734.pub2.

4. Orthodontic retention and stability: a clinical perspective. Rinchuse DJ, Miles PG, Sheridan JJ. J Clin Orthod. 2007 Mar;41(3):125-32.

5. Long-term results of permanent bonded retention. Cerny R, Cockrell D, Lloyd D. Journal of Clinical Orthodontics. J Clin Orthod. 2010 Oct; 44 (10): pg 611-6


Disclaimer:

Please consider that the preceding article expresses general opinions and thoughts of the author(s), and should not be construed as explicit treatment recommendations for a specific patient. The evidence is constantly changing, and readers are encouraged to continuously update their knowledge base. The post is meant to inform the reader of what is available in the specialty literature at time of publishing.  

 

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